A False Sense of Hypoglycemia

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By Nora Saul, M.S., R.D., C.D.E., Manager of Nutritional Services at Joslin

Hypoglycemia is defined as a blood glucose level below 70mg/dl. But many people find that they feel the symptoms of low blood glucose at levels much higher than expected.  Some patients have come into my office reporting getting sweaty, hungry and tachycardic at levels in the mid 130s.

Symptoms of hypoglycemia are individual, but may include extreme hunger, nervousness, excessive perspiration, rapid heartbeat (tachycardia), headache, fatigue, mood changes, blurred vision and difficulty concentration and completing mental tasks. Extremely low glucose levels can lead to disorientation and convulsions.

People who take insulin or some oral medications that cause the pancreas to produce insulin are usually prone to episodes of hypoglycemia.  This is especially true if they are attempting to keep their glucose level as close to normal as possible.  But, people in poor control can also have hypoglycemic reactions as they swing from high to low glucose levels.

False hypoglycemia is usually due to one of two causes. The first can be compared to an incorrectly programmed thermostat. If you usually keep your room at a steamy 85 degrees, 70 degrees might start to feel chilly.

People whose blood glucose is often high trick their body into thinking this is normal. If they rapidly bring their blood glucose into the normal range their bodies’ trigger the same autonomic and neurological warnings as if their blood glucose had fallen into the danger zone.

Gradually bringing yourself into better control will help accustom your body to lower blood glucose levels.

The other cause of pseudo-hypoglycemia occurs when glucose levels drop rapidly in a short time period. This can happen when exercising vigorously and can occur even in those in good control.

The first thing to do when you experience manifestations of hypoglycemia is to confirm the diagnosis with the use of your meter. If you really are in a danger zone, the appropriate treatment for low blood glucose is to take 15 grams of an easily absorbable carbohydrate, wait 15 minutes and then recheck.  If the glucose level hasn’t reached 80mg/dl then a second carbohydrate load is indicated.

But what should you do if your meter says 110 mg/dl and you have already checked twice? The first thing is to relax. Knowing you are not having a low blood glucose reaction and there is no urgency to do anything should help reduce your anxiety. And then you can decide if you are capable of “waiting it out” knowing you will feel better in time.

If that isn’t possible, then take a small amount of carbohydrate to relieve symptoms.  For example, you may decide to see if 5 grams of carbohydrate (the amount in one glucose tab or 1 teaspoon of sugar) will alleviate your discomfort without causing your blood glucose levels to skyrocket.

7 Responses to A False Sense of Hypoglycemia

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  2. Christine says:

    It’s important to note that there is a monogenic form of diabetes, MODY 2, in which hypoglycemia does really occur at a higher level than indicated. With MODY 2, the body is programmed to run at a higher baseline fasting glucose (about 30-40 mg/dl higher than the typical 70-100 mg/dl that’s considered “normal” for most), and the counter-regulatory responses to hypoglycemia (release of epinephrine and glycogen from the liver) occur in the 90’s as opposed to the 60’s for others.

  3. Natalie says:

    Sometimes I’ve noticed that I’ve just dropped too fast….my novolog really did it’s job (when I’m going from 220 to 118 in 30 minutes at insulin peak) What helps for me when I’m 100 and dizzy and hungry after is to eat something with carbs fat protein but take the amount of insulin to keep it in target (peanut butter and jelly on 1 slice of toast plus insulin). Then I’m not yoyoing but the madness stops.

  4. Arielle says:

    I’ve lived with hypoglycemia all my life as everyone in my family has but I’ve never had a meter. After yesterday I know now that I must get one. I have had mild attacks where I would get a little shaky and feel extremely hungry and get cranky that I would easily fix with eating. I’ve now had two major attacks in my life. The first one I had no access to a meter to be able to say how low it got, but I would up passing out for a minute. I wound up recovering slowly, but safely. Yesterday was another case of an attack but once again I didn’t have access to a meter until I had already risen my blood sugar. I was at work checking out a customer when I started to get sweaty and a feeling that I was going to puke. I knew immediately that it was because I didn’t eat breakfast due to ruining late. Stupid of me, I know. I tried to just make it through until my break but it got progressively worse very quickly. I was sure that I was about to pass out. I called over my manager and was told that I looked pale and should go rest. I went to the bathroom immediately without anything happening and the feeling getting worse. I then went straight for food and a protein shake. After awhile I thought that I might be feeling better and tried to get back to work. The second I stood up it all came back. I thought that maybe it was just taking longer than usual to fix and continued to work. I had to stop again with the feeling of about to pass out or puke. This went on for an hour until my boss came up and told me to go to the pharmacy in our store to get my blood sugar tested. I had no idea that we could do that. I went straight over and got a reading of 82. Normally this is fine but in this case a bit concerning after I had eaten and had given it time to set. I was told to buy the tablets and eat a couple and to come back in 15. The next reading was the same. We began to wonder if the meter was reading correctly so we took another of the same blood spot and it came up as 71. I was then told to eat more tablets and drink some juice. After another 15 and feeling no different I went to the doctors. An hour later and it was up to 140. The rest of my day I spent laying on the couch feeling horrible and exhausted. I never want to go through that again.

  5. cheddar says:

    Ive been having these episodes almost daily for 2 weeks. I had a couple days where it didnt happen at all, but i get hungry, shaky, sweaty, weird vision etc. Took the 3 hour sugar test and it came back positive for hypoglycemia. My 4th and final reading was at apparently at 60. I check my meter all the time to the point it annoys my wife and it’s never been under 79. typically its 82, 84, 94, 92, 102. I’ve also had high anxiety and depression my whole life and i wonder if this is happening because of that? The symptoms are almost exactly the same so i have a hard time telling the difference. I’ve ready to drink juice or eat sugar, but my doctor called me this morning and said AVOID all simple sugar and juices. I was massively confused as i thought thats what diabetics had to do. I thought i need sugar. Turns out, i guess, i need protein, complex carbs and fat. I’m so confused and a little scared. Seems that its rare for people to have just hypoglycemia

  6. Marina says:

    Hypoglycemia the forgotten sugar disorder. I am waiting on my results of a 3 hour test. Although I am very sad because my sugar didn’t drop therefore doctor would probably say I have nothing and it is anxiety. I just had a low episode with 82. Felt horrible and my mom was telling your sugar is fine. But I feel horrible at 82. It so scary it makes me very depressed and I don’t want to do anything or go anywhere because I am afraid. I else have a baby boy and I am so scare for him. I whish science gets into searching hypoglycemia more and find a cure. I’m sorry we have to go through this

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